Cerebral Palsy (CP) is a term used to describe a group of disorders affecting body movement and muscle co-ordination. The medical definition of cerebral palsy is a “non-progressive” but not unchanging disorder of movement and/or posture, due to an insult to or anomaly of the developing brain. Development of the brain starts in early pregnancy and continues until about age three. Damage to the brain during this time may result in CP. This damage interferes with messages from the brain to the body and from the body to the brain. The effects of CP vary widely from individual to individual. At its mildest, CP may result in a slight awkwardness of movement or hand control. At its most severe, CP may result in virtually no muscle control, profoundly affecting movement and speech. Depending on which areas of the brain have been damaged, one or more of the following may occur: muscle tightness or spasms, involuntary movement, difficulty with “gross motor skills” such as walking or running, difficulty with “fine motor skills” such as writing or doing up buttons.
These effects may cause associated problems such as difficulties in feeding, poor bladder and bowel control, breathing problems, and pressure sores. The brain damage which caused CP may also lead to other conditions such as: seizures, learning disabilities or developmental delay.
CP is not a progressive condition—damage to the brain is a one-time CP event so it will not get worse—and people with CP have a normal lifespan. Although the condition is not progressive, the effects of CP may change over time. Some may improve: for example, a child whose hands are affected may be able to gain enough hand control to write and to dress him/herself. Others may get worse: tight muscles can cause problems in the hips and spine of growing children which require orthopedic surgery; the aging process can be harder on bodies with abnormal posture or which have had little exercise.
Treatment programs are tailored to individual needs and vary as new medical issues develop. Muscle stimulating physical and occupational therapies are important because they increase both muscle strength and tone and prevent disuse atrophy. A number of known art devices exist to stimulate muscle action but these devices and therapies almost exclusively focus on the skeletal muscles. Skeletal muscles are also called voluntary muscles because they can be controlled. Examples would include the biceps which are used when lifting an object. Voluntary muscles may be stimulated by Transcutaneous Electrical Nerve Stimulation (TENS) or by moving the bones they are connected to.
Treatment programs generally ignore the smooth muscles of the body also called the involuntary muscles and the internal myofascia surrounding these muscles. The myofascia covers, supports and separates muscles. Each muscle fiber is wrapped with myofascia, bundles of those fibers are wrapped with myofascia, and the whole muscle is also wrapped in myofascia. Myofascial tissue is dynamic: under strain it increases in density and relative rigidity, giving the muscles more support.
Many of these muscles are used for tasks in the body that require no thought in daily life such as digestion and focusing your eyes. A number of these muscles are also used to stabilize the body. When these smooth stabilization muscles become weak, the posture, form and mobility of the body are compromised and the skeletal structure itself may begin to collapse. These muscles are often deep inside the body and are therefore impossible to reach with conventional TENS or joint-action based therapies.
In individuals with CP or similar disorders, the smooth stabilization muscles and internal myofascia may become weak because they are not challenged or directly addressed in daily life. For example, a child who has no control over his back muscles may also suffer from improperly developed back stabilization muscles and associated myofascia which in turn leads to a weakening of the entire body structure.
Advanced Biomechanical Rehabilitation (ABR) has been used for more than a decade to coax the smooth stabilization muscles, internal myofascia and related structures to react to forces applied to the body by a care-giver's massage. This therapeutic massage is performed by applying force to specific regions of the body using the hands. Four critical parameters of the massage are:
The force must be applied evenly over the whole surface of the hand with no high or low pressure points using a motion that is piston-like in that it can push into the body and be withdrawn from the body in smoothly controlled movements.
The force must be applied very gradually, increasing slowly to a peak, hold the pressure, then gradually reduce the pressure. This ensures the force reaches the smooth muscles and internal myofascia deep within the body and gives them time to react. Applying the massage improperly will cause the contraction of the muscles in the exterior regions of the body which will therefore absorb part of the forces being applied instead of allowing them to pass deeper into the body. This diminishes the effectiveness of the massage treatment since the forces are diluted in the exterior muscles and myofascia.
The massage is made up of pressure cycles. Each individual pressure cycle will have an effect on the body. The massage is therefore effective from the very first application of pressure. However, the individual effects are very small, a large number of pressure cycles may therefore be required to see the benefits of the massage. It is the summation of the effects of all the pressure cycles that is most important, the overall number, duration and application of the pressure cycles may be varied as the massage progresses to ensure the appropriate application for maximum benefit. In some cases the massage will be applied for thousands of hours over the course of years, in other cases the total massage time may be only a few hundred hours.
The massage will be applied at various locations around the body. Those areas in need of treatment are accessed by the professional at a clinic. There are no specific areas of the body that will always require treatment, and similarity there are no areas of the body that never require treatment. The effects of CP vary from person to person, and so too will the application of the massage.
It is extremely difficult for care-givers to learn the proper technique to apply the ABR massage and to find the time to consistently apply the massage for hundreds and sometimes thousands of hours over the course of treatment. A mechanized method of performing a therapeutic massage is therefore desired.
One example of a therapeutic massage device is described in U.S. Pat. No. 4,838,263 entitled “Chest Compression Apparatus” issued to Warwick et al on June 13, 1989. The 263 patent describes a device comprising a vest-type bladder covering the chest of the individual and means for inflating and deflating the vest. The application of pressure pulses and the pulse rate is controlled by the individual. The pressure pulses are designed to be very quick and strong to dislodge mucus from the lungs. There is no need for precise control over pressure, distribution of force, or number of pressure cycles. Another example of the known art is described in U.S. Pat. No. 6,471,663 issued to Brunt and Gagne on Oct. 29, 2002 and entitled “Chest compression vest with connecting belt. The 663 patent includes an inflatable bladder that is wrapped around the chest of the individual. The bladder is inflated using compressed air and then deflated. The 663 patent describes an uncomfortable and intrusive device. It does not address the requirement for following a precise and therapeutic application of massage that could be used to strengthen muscles.
Therefore there exists in the known art of massage therapy devices shortcomings relating to the size of the apparatus, the ability of the apparatus to correctly apply the massage therapy with the required methods and parameters and the comfort of the apparatus and the trouble that an individual or care-giver may have in the self-application of a precise therapeutic regime as prescribed by a professional. There also exists a need to monitor the massage therapy to ensure that it is being properly applied and not over-applied by unskilled caregivers who are sometimes of the belief that if a little massage therapy is good, then more must be better.